Shanbhag Swapna S, Koduri Madhuri A, Kannabiran Chitra, Donthineni Pragnya R, Singh Vivek, Basu Sayan
The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India.
Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.
Front Genet. 2021 Jan 12;11:607532. doi: 10.3389/fgene.2020.607532. eCollection 2020.
This review attempts to collate all the studies performed in India or comprising a population originating from India and to find out if there is an association between the HLA (human leucocyte antigen) type of individual and development of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) subsequent to medication use. The authors performed a PubMed search of all articles published in English from 2009 to 2019 for articles that studied HLA type in patients who developed SJS/TEN after intake of a specific drug in the Asian Indian population or in individuals of Asian Indian origin. The selection criteria were satisfied by a total of 11 studies that reported HLA associations with specific drugs, which induced SJS/TEN, mainly anti-epileptic drugs, and cold medicine/non-steroidal anti-inflammatory drugs. These studies involved a small number of patients, and hence, there is limited evidence to conclude if these associations can be extrapolated to a larger population of the same ethnicity. Similar multi-center studies need to be conducted with a larger sample size to confirm these associations. This would have implications in policy making and for understanding the potential of using genetic markers as a screening tool before prescribing a drug to a patient, which might make them susceptible to developing a potentially life-threatening disease such as SJS/TEN. This is possibly the only mode of primary prevention for this potentially fatal severe cutaneous adverse drug reaction.
本综述试图整理所有在印度进行的研究，或纳入印度裔人群的研究，以查明个体的人类白细胞抗原（HLA）类型与用药后发生史蒂文斯 - 约翰逊综合征/中毒性表皮坏死松解症（SJS/TEN）之间是否存在关联。作者在PubMed上检索了2009年至2019年发表的所有英文文章，查找那些研究亚洲印度人群或亚洲印度裔个体在摄入特定药物后发生SJS/TEN患者的HLA类型的文章。共有11项研究满足选择标准，这些研究报告了HLA与导致SJS/TEN的特定药物之间的关联，主要是抗癫痫药物、感冒药/非甾体抗炎药。这些研究涉及的患者数量较少，因此，若要推断这些关联是否适用于同一民族的更多人群，证据有限。需要开展样本量更大的类似多中心研究来证实这些关联。这将对政策制定以及理解在给患者开药前使用基因标记作为筛查工具的潜力具有启示意义，因为这可能使患者易患如SJS/TEN这类潜在的危及生命的疾病。这可能是针对这种潜在致命的严重皮肤药物不良反应的唯一一级预防方式。
